From Care Plans to Care - PowerPoint Presentation

Slide1

From Care Plans to Care Coordination: Opportunities for Computer Support of Teamwork in Complex Healthcare

Ofra Amir, Barbara Grosz, Krzysztof

Gajos

Harvard School of Engineering and Applied Sciences

Sonja Swenson, Lee

Sanders

Stanford UniversitySlide2

Parents

Primary Care Provider

Physical Therapist

Neurologist

School nurse

Camp counselor

Health aide

Teacher

Speech Therapist

GI

The Care for Children with Complex Chronic Conditions

The Problem:

care for children with complex conditions is poorly coordinated, leading to unmet health needs and preventable health care crisesSlide3

Team-Based Care Plans for Improved Coordination (LPFCH, 2014)

Goals

Actions

CaregiversMove to oral feeds

Improve mouth muscle toneAdjust formula for weight gain

PCP, GI, OT, nutritionistStart daycare

Minimize need for tube feeds

Assess therapy needs

Parents, PCP, nutritionist, home nurseGo on family trip

Arrange portable equipmentArrange funding and transportationParents, PCP, PT, social worker

Rationale:

everybody “on the same page”In practice:

rarely deployed or consulted Slide4

ContributionsA qualitative study of complex care teamsCare coordination challengesBarriers to effective care plan implementation

Defining “FLECS” teamwork characteristics

Foundations for

technology design based on a computational teamwork theorySlide5

Study of Complex Care TeamsGoal: understand care coordination challengesInterviews and observations of team members:

Parents (13)

Primary care providers (4)Specialists (4)Therapists (8)

Care coordinator (1)Program directors (2)Family services coordinator (1)Social worker (1)Analyzed using affinity diagrammingSlide6

Barriers to Effective Care Plan Use:Complex Teamwork in Complex Care“

FLECS

” teamwork characteristics: F

lat-structure of teamLoosely coupled plans and activities

Extended duration of plans Continual distributed revision of

plansSyncopated time scalesSlide7

Flat Structure

No single person in charge:

“We have different goals for different specialists; it is hard to keep track.” (parent

)Need to prioritize goals because “everyone wants to work on everything.” (parent)Slide8

Loosely Coupled Activities

Loose coupling makes appropriate information sharing hard:

“There isn’t an example when I wasn’t missing

information” (specialist)“We need to relay information back and forth...”

(parent)Slide9

Extended Duration,Continual Distributed Plan Revision

No mechanism to support plan revision:

Full-team meetings “totally not scalable”

(specialist)“All the status chats have to be provider initiated, and so if you don’t remember to do it or there’s no one coordinating it, it’s like where is it going, where do you even look for it

?” (specialist)Slide10

Syncopated Time ScalesDifferent frequencies of seeing the patient

Primary care providers: 3 to 4 times a year

Specialists: 2 to 3 time a yearTherapists: 1 to 3 times a week

Different information needs:“A doctor asks if she is walking and expects a yes/no

answer; a physical therapist will ask how she is walking and how much progress she has made.” (parent)Slide11

Team-Based Care Plans: Ideal vs. RealityFLECS teamwork poses coordination challenges

Principles for successful care plan use

(LPFCH,

2014) do not hold:“The plan of care is systematized as a common, shared document;

it is used consistently by every provider…”“The team monitors progress

against goals, provides feedback and adjusts the plan of care on an ongoing basis…”

“Family-centered care teams can access the information they need to make shared, informed decisions.”

How can technology better

support such complex teamwork?Slide12

Technology for Supporting TeamworkFLECS teamwork goes beyond prior work

Supporting healthcare teams

Temporal coordination

(Bardram 2000)Centralized re-planning

(Bardram 2010

)Mobile home care teams (Pinelle

& Gutwin 2006)

CSCW and social science teamwork theories and tools

(Hutchins 1996 ; Star & Griesemer 1989; Hinds and McGrath 2006; Reddy & Spence 2008;…)Slide13

Foundations for Design of Systems to Support Complex Care TeamsSharedPlans

(Grosz &

Kraus 1996)

: A computational theory of collaboration

“..the capabilities needed for collaboration cannot be patched on but must be designed in from the start.

"Slide14

SharedPlans

Representation

adjust formula

funding & transportation

follow family priorities

move to oral feeds

go on family trip

improve mouth muscle tone

{parents, primary care provider, specialists, therapists, community members}

{primary care provider, physical therapist, social worker}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}

arrange equipment

{…}

{…}

{…}

{…}Slide15

adjust formula

arrange equipment

go on family trip

move to oral feeds

SharedPlans

Representation

funding & transportation

follow family priorities

{parents, primary care provider, specialists, therapists, community members}

{primary care provider, physical therapist, social worker}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}

{…}

{…}

{…}

{…}

improve mouth muscle toneSlide16

improve mouth muscle tone

SharedPlans

Representation

adjust formula

arrange equipment

go on family trip

move to oral feeds

funding & transportation

follow family priorities

{parents, primary care provider, specialists, therapists, community members}

{primary care provider, physical therapist, social worker}

{…}

{…}

{…}

{…}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}Slide17

adjust formula

Agreement on

High-Level Approach, Mutual Beliefs

funding & transportation

follow family priorities

move to oral feeds

go on family trip

improve mouth muscle tone

{parents, primary care provider, specialists, therapists, community members}

{primary care provider

,

physical therapist, social worker}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}

arrange equipment

{…}

{…}

{…}

{…}Slide18

Agreement on High-Level Approach, Mutual Beliefs

Opportunity for Technology Support:

make care plan “ever-present”

adapt presentation to team members

Current Systems:

care plans are not integratedno adaptation of plan informationSlide19

Dynamically Evolving Plans

…

…

…

…

funding & transportation

follow family priorities

move to oral feeds

go on family trip

improve mouth muscle tone

adjust formula

arrange equipment

{parents, primary care provider, specialists, therapists, community members}

{primary care provider, physical therapist, social worker}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}

{…}

{…}

{…}

{…}Slide20

Dynamically Evolving Plans

Opportunity for Technology Support:

d

ynamic plan structure

support revision and expansion

Current Systems:

static, flat representationSlide21

adjust formula

…

…

…

…

funding & transportation

follow family priorities

move to oral feeds

go on family trip

improve mouth muscle tone

{parents, primary care provider, specialists, therapists, community members}

{primary care provider, physical therapist, social worker}

{primary care provider, gastroenterologist, occupational therapist, nutritionist}

arrange equipment

Communication and Coordination

{…}

{…}

{…}

{…}Slide22

Communication and Coordination

Opportunity for Technology Support:

improved information sharing interfaces

reasoning about team members’ context

Current Systems:

little organization and contextinformation overloadSlide23

Key Roles for Technology for Supporting Complex Care Teams

Make

the care plan “ever present”Support plan revision and expansion

Support efficient information sharingChallenges:

Eliciting plansInferring context in planReasoning about information sharingSlide24

Ongoing Work: GoalKeeperSlide25

Ongoing Work: Information Sharing Algorithms

What information to share?

Who to share information with?

When

to share information ?

How to present information?Slide26

Ongoing Work:Supporting Collaborative Writing

**Come check

out

our WiP

poster today** Deploying AI Methods to Support Collaborative Writing:

a Preliminary Investigation Gehrmann

, Urke, Amir and Grosz, 2015Slide27

ConclusionQualitative study of complex care teamsIdentifying FLECS teamwork characteristics Foundations for technology design from computational teamwork theories

Ongoing work toward designing such systems…

Ofra Amir, Barbara Grosz, Krzysztof

Gajos

Harvard School of Engineering and Applied Sciences

Sonja Swenson, Lee

Sanders

Stanford University